Iranian Center for Endodontic Research, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, 1983963113, Tehran, Iran.
Endodontology Research Center, Endodontic Department, Dental School, Kerman University of Medical Sciences, 7618751689, Kerman, Iran.
Clin Oral Investig. 2022 Mar;26(3):3287-3297. doi: 10.1007/s00784-021-04310-y. Epub 2021 Dec 2.
The concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in mature permanent teeth with carious pulp exposure, including irreversible pulpitis (IP) cases. Consequently, VPT needs to be compared with root canal therapy (RCT) in terms of treatment outcomes. This randomized clinical trial compares the results of full pulpotomy using two calcium-silicate cements, i.e., mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement, with RCT in mature permanent teeth.
A total of 157 carious pulp exposure cases in two academic centers with/without established IP were selected/included/randomly appointed to three study arms; (i) RCT (n = 51) as the reference treatment, (ii) pulpotomy with ProRoot MTA (PMTA; n = 55), and (iii) pulpotomy with CEM cement (PCEM; n = 51) as two alternative VPT treatments. Two-year clinical/radiographic results were the outcomes of interest. Data were statistically analyzed through the analysis of variance, chi-square, Fisher exact test, and Kruskal-Wallis.
At 2-year recall, 147 teeth were examined (6.4% dropout). All molars, except for one, were clinically functional/symptom-free, and there was no statistical difference between the three study arms (p = 0.653). The radiographic success rates in RCT, PMTA, and PCEM arms were 98%, 100%, and 97.9%, respectively, without statistically significant differences (p = 0.544).
In the management of mature permanent teeth with/without established IP, all experimental groups exhibited equivalent/comparable results.
Simple VPT using MTA/CEM can be suggested/recommended as a viable advantageous alternative to RCT for the management of carious pulp exposures with/without sign/symptoms of IP.
微创牙髓治疗学的理念推荐在有龋坏牙髓暴露的成熟恒牙中采用微创有活力牙髓治疗（VPT）方式替代更具侵袭性的传统牙髓治疗方法，包括不可复性牙髓炎（IP）病例。因此，VPT 需要在治疗效果方面与根管治疗（RCT）进行比较。本随机临床试验比较了使用两种钙硅酸盐水泥（即三氧化矿物聚合体（MTA）和钙强化混合水泥（CEM））进行全盖髓术与 RCT 在成熟恒牙中的结果。
在两个学术中心，共选择/纳入/随机分配了 157 例有/无已确立 IP 的龋坏牙髓暴露病例到三个研究组；（i）RCT（n=51）作为参考治疗，（ii）ProRoot MTA 盖髓术（PMTA；n=55），和（iii）CEM 水泥盖髓术（PCEM；n=51）作为两种替代 VPT 治疗。2 年的临床/影像学结果是关注的结局。通过方差分析、卡方检验、Fisher 确切检验和 Kruskal-Wallis 检验对数据进行统计学分析。
在 2 年的随访中，检查了 147 颗牙齿（6.4%的失访率）。除一颗磨牙外，所有磨牙均具有临床功能/无症状，且三个研究组之间无统计学差异（p=0.653）。RCT、PMTA 和 PCEM 组的放射学成功率分别为 98%、100%和 97.9%，无统计学差异（p=0.544）。
在管理有/无已确立 IP 的成熟恒牙时，所有实验组均表现出等效/可比的结果。
使用 MTA/CEM 的简单 VPT 可作为 RCT 的可行有利替代方案，用于治疗有/无 IP 症状/体征的龋坏牙髓暴露。
